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We assess the CALIPSO Version 4.2 (V4) aerosol typing and assigned lidar ratios over ocean using aerosol optical depth (AOD) retrievals from the Synergized Optical Depth of Aerosols (SODA) algorithm and retrieved columnar lidar ratio estimated by combining SODA AOD and CALIPSO attenuated backscatter (CALIPSO–SODA). Six aerosol types – clean marine, dusty marine, dust, polluted continental/smoke, polluted dust, and elevated smoke – are characterized using CALIPSO–SODA over ocean and the results are compared against the prescribed V4 lidar ratios, when only one aerosol type is present in the atmospheric column. For samples detected at 5 or 20 km spatial resolutions and having AOD > 0.05, the CALIPSO–SODA lidar ratios are significantly different between different aerosol types, and are consistent with the type-specific values assigned in V4 to within 10 sr (except for polluted continental/smoke). This implies that the CALIPSO classification scheme generally categorizes specific aerosols types correctly over regions where they are abundant. We find remarkable daytime/nighttime regional agreement for clean marine aerosol over the open ocean (CALIPSO–SODA = 20–25 sr, V4 = 23 sr), elevated smoke over the southeast Atlantic (CALIPSO–SODA = 65–75 sr, V4 = 70 sr), and dust over the subtropical Atlantic adjacent to the African continent (CALIPSO–SODA = 40–50 sr, V4 = 44 sr). In contrast, daytime polluted continental/smoke lidar ratio is more than 20 sr smaller than the constant V4 value for that type, attributed in part to the challenge of classifying tenuous aerosol with low signal-to-noise ratio. Dust over most of the Atlantic Ocean features CALIPSO–SODA lidar ratios less than 40 sr, possibly suggesting the presence of dust mixed with marine aerosols or lidar ratio values that depend on source and evolution of the aerosol plume. The new dusty marine type introduced in V4 features similar magnitudes and spatial distribution as its clean marine counterpart with lidar ratio differences of less than 3 sr, and nearly identical values over the open ocean, implying that some modification of the classification scheme for the marine subtypes is warranted.

Satellite quantification of aerosol effects on clouds relies on aerosol optical depth (AOD) as a proxy for aerosol concentration or cloud condensation nuclei (CCN). However, the lack of error characterization of satellite-based results hampers their use for the evaluation and improvement of global climate models. We show that the use of AOD for assessing aerosol–cloud interactions (ACIs) is inadequate over vast oceanic areas in the subtropics. Instead, we postulate that a more physical approach that consists of matching vertically resolved aerosol data from the Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observations (CALIPSO) satellite at the cloud-layer height with Moderate Resolution Imaging Spectroradiometer (MODIS) Aqua cloud retrievals reduces uncertainties in satellite-based ACI estimates. Combined aerosol extinction coefficients (σ) below cloud top (σBC) from the Cloud-Aerosol Lidar with Orthogonal Polarization (CALIOP) and cloud droplet number concentrations (Nd) from MODIS Aqua yield high correlations across a broad range of σBC values, with σBC quartile correlations ≥0.78. In contrast, CALIOP-based AOD yields correlations with MODIS Nd of 0.54–0.62 for the two lower AOD quartiles. Moreover, σBC explains 41 % of the spatial variance in MODIS Nd, whereas AOD only explains 17 %, primarily caused by the lack of spatial covariability in the eastern Pacific. Compared with σBC, near-surface σ weakly correlates in space with MODIS Nd, accounting for a 16 % variance. It is concluded that the linear regression calculated from ln(Nd)–ln(σBC) (the standard method for quantifying ACIs) is more physically meaningful than that derived from the Nd–AOD pair.

Aerosol extinction coefficients (σa) and lidar ratios (LRs) are retrieved over the ocean from CALIPSO's Cloud-Aerosol Lidar with Orthogonal Polarization (CALIOP) attenuated backscatter profiles by solving the lidar equation constrained with aerosol optical depths (AODs) derived by applying the Synergized Optical Depth of Aerosols (SODA) algorithm to ocean surface returns measured by CALIOP and CloudSat's Cloud Profiling Radar. σa and LR are retrieved for two independent scenarios that require somewhat different assumptions: (a) a single homogeneous atmospheric layer (1L) for which the LR is constant with height and (b) a vertically homogeneous layer with a constant LR overlying a marine boundary layer with a homogenous LR fixed at 25 sr (two-layer method, 2L). These new retrievals differ from the standard CALIPSO version 4.1 (V4) product, as the CALIOP–SODA method does not rely on an aerosol classification scheme to select LR. CALIOP–SODA σa and LR are evaluated using airborne high-spectral-resolution lidar (HSRL) observations over the northwest Atlantic. CALIOP–SODA LR (1L and 2L) positively correlates with its HSRL counterpart (linear correlation coefficient r>0.67), with a negative bias smaller than 17.4 % and a good agreement for σa (r≥0.78) with a small negative bias (≤|-9.2%|). Furthermore, a global comparison of optical depths derived by CALIOP–SODA and CALIPSO V4 reveals substantial discrepancies over regions dominated by dust and smoke (0.24), whereas Aqua's Moderate resolution Imaging Spectroradiometer (MODIS) and SODA AOD regional differences are within 0.06. Global maps of CALIOP–SODA LR feature high values over littoral zones, consistent with expectations of continental aerosol transport offshore. In addition, seasonal transitions associated with biomass burning from June to October over the southeast Atlantic are well reproduced by CALIOP–SODA LR.

Abstract Introduction Enteral nutrition (EN) is the recommended nutritional support in most critically ill populations. When given by feeding tube, EN may be administered either continuously or intermittently. It is unclear which approach is superior in reducing gastrointestinal complications—such as diarrhea—and meeting nutritional targets. The main objectives of this systematic review and meta-analysis are to (1) determine whether continuous or intermittent enteral nutrition is associated with higher incidence of adverse gastrointestinal outcomes, including diarrhea, and (2) determine which feeding modality is associated with reaching nutritional goals. Methods and analysis This systematic review protocol is reported in accordance with guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement. We will search MEDLINE, Embase, the Cochrane Library, and the World Health Organization (WHO) International Clinical Trials Registry (ICTRP) search portal for studies comparing continuous EN and intermittent EN in critically ill patients with no date or language restrictions. Studies will be screened, selected, and extracted independently and in duplicate. We will assess the risk-of-bias assessment using the Cochrane Collaboration’s Risk of Bias (RoB) 2 tool. The primary outcome will include the incidence of diarrhea; secondary outcomes include other adverse GI outcomes (nausea, vomiting, abdominal pain, and constipation), as well as reaching nutritional goals, and length of ICU and hospital stay and mortality. We will pool data using a random-effects model and assess the certainty of the evidence for each outcome using Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. Ethics and dissemination Ethics approval is not required for this study as no original data will be collected. We will disseminate results through peer-reviewed publication and conference presentations. Systematic review registration PROSPERO CRD42022330118.

Abstract Objective To assess asymptomatic rates and severity of SARS‐CoV‐2 infection in people with epilepsy and their healthcare workers in a long‐term care facility which had implemented weekly surveillance testing between April 2020 and June 2022. Methods Questionnaires focused on objective and subjective COVID‐19 symptoms for people with epilepsy residing in and their healthcare workers at the Chalfont Centre for Epilepsy in June 2022. Demographic information, comorbidities, and seizure frequency were gathered from medical records. We also collected responses on objective and subjective COVID‐19 symptoms from healthcare workers who participated in a prospective study assessing the reaction to COVID‐19 vaccinations (SAFER). Results Fifty‐five out of 89 (62%) residents tested positive at least once on weekly PCR testing for SARS‐CoV‐2 during the period of interest; 20 of those (37%) were asymptomatic. In comparison, of those 63 healthcare workers who tested positive at least once on weekly testing during the same period, only four (6%) were asymptomatic. Of the 159 healthcare workers who also participated in the SAFER study, 41 tested positive at least once, and seven (17%) were completely asymptomatic during infection with SARS‐CoV‐2. Significance People with epilepsy living in a long‐term care facility were more likely to present with asymptomatic SARS‐CoV‐2 infections than healthcare workers at the same facility. Despite possible bias in the reporting of subjective symptoms due to management‐by‐proxy, there is no evidence that vulnerable people living in an epilepsy long‐term care facility showed reduced resilience towards infections. Plain Language Summary People with epilepsy living in care home facilities had a surprisingly high degree of asymptomatic infections with SARS‐CoV‐2. Very few residents had severe or fatal outcomes. This is in stark contrast to the widely reported bad outcomes for people without epilepsy in other care homes. People with epilepsy reported significantly less symptoms than their healthcare workers. No changes in seizure frequency during or after infection were observed.

Objectives Paramedics have the potential to make a substantial contribution to community-based palliative care provision. However, they are hindered by a lack of policy and institutional support, as well as targeted education and training. This study aimed to elicit paramedics’, palliative care doctors’ and nurses’, general practitioners’, residential aged care nurses’ and bereaved families and carers’ attitudes and perspectives on how palliative paramedicine can be improved to better suit the needs of community-based patients, their families and carers, and the clinicians involved in delivering the care.Design In this qualitative study underpinned by a social constructivist epistemology, semistructured interviews were conducted.Setting and participants 50 participants with palliative paramedicine experience, from all jurisdictions of Australia. Participants were interviewed between November 2021 and April 2022.Results All participants suggested paramedics play an important adjunct role in the provision of palliative and end-of-life care in home-based settings. Three levels of opportunities for improvement were identified: macrolevel (policy and frameworks; funding and education; accessing medical records and a widening scope); mesolevel (service-level training; interprofessional understanding and communities of practice and community expectations) and microlevel (palliative care subspecialty; debriefing and self-care and partnering with families).Conclusion To enhance paramedic capacity to provide palliative care support, improvements targeting systems, services, communities and individuals should be made. This calls for stronger inclusion of paramedicine in interdisciplinary palliative care and greater investment in both the generalist and specialist palliative paramedicine workforce.

Abstract Objectives Falls are common in adults aged 65 years and older and are the leading cause of traumatic brain injuries in this age group. Alcohol use may increase the risk of falls as well as the severity of resultant injuries. The aim of this study was to examine the association between self‐reported alcohol use and the prevalence of intracranial hemorrhage (ICH) in this patient group. Methods This was a secondary analysis of the Geriatric Head Trauma Short Term Outcomes Project (GREAT STOP), a study of older adults with blunt head trauma from a fall. We determined the characteristics of every fall event, including patient demographics and medical history, and clinical signs and symptoms related to head trauma. Self‐reported alcohol use was categorized as none, occasionally, weekly, or daily. We defined ICH as any acute ICH detected by computed tomography scan. We evaluated the association between alcohol use frequency and ICH, adjusted for patient factors and head injury risk factors. Results Of 3128 study participants, 18.2% (n = 567) reported alcohol use: 10.3% with occasional use, 1.9% with weekly use, and 6.0% with daily use. ICH was more common in patients who used alcohol (20.5%, 22.0%, and 25.1% for occasional, weekly, and daily alcohol users, respectively, vs. 12.0% for non‐users, p

Despite its proven research applications, it remains unknown whether surface electromyography (sEMG) can be used clinically to discriminate non-lame from lame conditions in horses. This study compared the classification performance of sEMG absolute value (sEMGabs) and asymmetry (sEMGasym) parameters, alongside validated kinematic upper-body asymmetry parameters, for distinguishing non-lame from induced fore- (iFL) and hindlimb (iHL) lameness. Bilateral sEMG and 3D-kinematic data were collected from clinically non-lame horses (n = 8) during in-hand trot. iFL and iHL (2–3/5 AAEP) were induced on separate days using a modified horseshoe, with baseline data initially collected each day. sEMG signals were DC-offset removed, high-pass filtered (40 Hz), and full-wave rectified. Normalized, average rectified value (ARV) was calculated for each muscle and stride (sEMGabs), with the difference between right and left-side ARV representing sEMGasym. Asymmetry parameters (MinDiff, MaxDiff, Hip Hike) were calculated from poll, withers, and pelvis vertical displacement. Receiver-operating-characteristic (ROC) and area under the curve (AUC) analysis determined the accuracy of each parameter for distinguishing baseline from iFL or iHL. Both sEMG parameters performed better for detecting iHL (0.97 ≥ AUC ≥ 0.48) compared to iFL (0.77 ≥ AUC ≥ 0.49). sEMGabs performed better (0.97 ≥ AUC ≥ 0.49) than sEMGasym (0.76 ≥ AUC ≥ 0.48) for detecting both iFL and iHL. Like previous studies, MinDiff Poll and Pelvis asymmetry parameters (MinDiff, MaxDiff, Hip Hike) demonstrated excellent discrimination for iFL and iHL, respectively (AUC > 0.95). Findings support future development of multivariate lameness-detection approaches that combine kinematics and sEMG. This may provide a more comprehensive approach to diagnosis, treatment, and monitoring of equine lameness, by measuring the underlying functional cause(s) at a neuromuscular level.

Abstract Objective Decisional conflict is used increasingly as an outcome measure in advance care planning (ACP) studies. When the Decisional Conflict Scale (DCS) is used in anticipatory decision‐making contexts, the scale is typically tethered to hypothetical scenarios. This study reports preliminary validation data for hypothetical scenarios relating to life‐sustaining treatments and care utilisation to inform their broader use in ACP studies. Methods Three hypothetical scenarios were developed by a panel of multidisciplinary researchers, clinicians and community representatives. A convenience sample of 262 older adults were surveyed. Analyses investigated comprehensibility, missing data properties, sample norms, structural, convergent and discriminant validity. Results Response characteristics suggested that two of the scenarios had adequate comprehensibility and response spread. Missing response rates were unrelated to demographic characteristics. Predicted associations between DCS scores and anxiety (r's = .31–.37, p

Background Horses commonly show asymmetries that manifest as left (L)-right (R) differences in vertical excursion of axial body segments. Moving on a circle confounds inherent individual asymmetries. Our goals were to evaluate individual and group asymmetry patterns and compare objective data with subjective impressions of side preference/laterality in horses walking on L and R circles. Methods Fifteen horses walked on L and R circles unridden and ridden on long and short reins. Optical motion capture (150 Hz) tracked skin-fixed markers. Variables were trunk horizontal angle; neck-to-trunk angle; vertical range of motion (ROM) for the head, withers and sacrum; ROM for pelvic roll, pitch, and yaw; mean pelvic pitch; and ROM for hip, stifle and tarsal joints. Differences between inside and outside hind steps were determined for vertical minima and maxima of the head (HMinDiff/HMaxDiff), withers (WMinDiff/WMaxDiff) and sacrum (PMinDiff/PMaxDiff). Subjective laterality was provided by owners. Data analysis used mixed models, first without and then with subjective laterality. Iterative k-means cluster analysis was used to associate biomechanical variables with subjective laterality. Results PMaxDiff, PMinDiff and WMaxDiff indicated R limb asymmetry in both directions. WMinDiff indicated L (inside) fore asymmetry for L direction but was close to zero for R direction. Hip ROM was significantly smaller for the inside limb in both directions (L inside/outside: 16.7° vs. 20.6°; R: 17.8° vs. 19.4°). Stifle ROM was significantly larger for the inside limb in both directions (L: 43.1° vs. 39.0°; R: 41.9° vs. 40.4°). Taking the general direction effect into account the R hip and L stifle had larger ROM. Adding laterality to the models (seven horses L- vs. six horses R-hollow), PMaxDiff R hind asymmetry was more obvious for L-hollow horses than for R-hollow horses. L-hollow horses had greater pelvic roll ROM moving in L vs. R direction. L-hollow horses had smaller inside and greater outside hip joint ROM in L vs. R direction. R-hollow horses had a significant difference in HMinDiff between L (0 mm) and R (−14 mm) directions, indicating less head lowering at outside forelimb midstance in R direction, and larger outside tarsal ROM in R (38.6°) vs. L (37.4°) direction (p ≤ 0.05). The variables that agreed most frequently with subjective laterality in cluster analysis were pelvic roll ROM, followed by HMinDiff and PMaxDiff. Conclusion Differences between horses walking in L and R directions were found both at group and individual levels, as well as evidence of associations with subjective laterality. Horses maintained more symmetric hip and stifle ROM and withers vertical motion when walking on the R circle. Findings suggest that left and right lateralised horses may not be perfect mirror images. Pelvic roll ROM emerged as a promising variable to determine laterality in walk as perceived by the rider, especially when considered together with other variables.

In the sport of dressage, one or more judges score the combined performance of a horse and rider with an emphasis on the technical correctness of the movements performed. At the end of the test, a single score is awarded for the ‘general impression’, which considers the overall performance of the horse and rider as a team. This study explored original measures that contributed to the general impression score in a group of 20 horse–rider combinations. Horses and riders were equipped with inertial measurement units (200 Hz) to represent the angular motion of a horse’s back and the motions of a rider’s pelvis and trunk. Each combination performed a standard dressage test that was recorded to video. Sections of the video were identified for straight-line movements. The videos were analyzed by two or three judges. Four components were scored separately: gaits of the horse, rider posture, effectiveness of aids, and harmony with the horse. The main contributor to the score for gaits was stride frequency (R = −0.252, p = 0.015), with a slower frequency being preferred. Higher rider component scores were associated with more symmetrical transverse-plane trunk motion, indicating that this original measure is the most useful predictor of rider performance.

This study follows a previously defined framework to investigate the impact of impairment on performance in Para dressage athletes. Twenty-one elite Para dressage athletes (grades I to V) and eleven non-disabled dressage athletes (competing at Prix St. Georges or Grand Prix) participated. Data were collected in two phases: performing a two minute custom dressage test on a riding simulator while kinematic data were synchronously collected using inertial measurement units (2000 Hz) and optical motion capture (100 Hz), and clinically assessed using a battery of impairment assessment tools administered by qualified therapists. Impairment and performance measures were compared between Para and non-disabled athletes. Significant differences between athlete groups were found for all impairment measures and two performance measures: simulator trunk harmonics (p = 0.027) and athlete trunk dynamic symmetry (p < 0.001). Impairment assessments of sitting function and muscle tone could predict 19 to 35% of the impact of impairment on performance in Para athletes but not in non-disabled athletes. These findings provide the basis for a robust, scientific evidence base, which can be used to aid in the refinement of the current classification system for Para dressage, to ensure that it is in line with the International Paralympic Committee’s mandate for evidence-based systems of classification.

Objectives Initiation of advance care planning (ACP) and palliative care (PC) assessments in general practice is key to quality end-of-life care. The Advance Project promotes a team-based approach to initiating ACP and PC needs assessment in general practices through training, resources and practical support for implementation from local primary health networks (PHNs). This paper aims to understand: (1) general practice participants’ experiences of undertaking Advance Project training and implementing the Advance Project resources in their practices; (2) barriers and facilitators to implementation of Advance Project resources; and (3) PHN staff experiences of supporting general practices through training and practical support for implementation of the Advance Project resources.Design Qualitative study using semistructured interviews and thematic analysis.Setting Twenty-one general practices and four PHNs from three Australian states were recruited between June 2019 and May 2020.Participants General practitioners (GPs), general practice nurses, practice managers (PMs) and PHN staff.Results 45 participants comprising 13 GPs, 13 general practice nurses, 9 PMs, 3 allied health staff and 7 PHN staff were interviewed. The general practice participants generally agreed that the Advance Project training/resources led to changes in their own behaviour and increased their awareness of the importance of ACP/PC discussion with their patients. Participants reported the following benefits for patients: increased awareness of ACP; engagement with families/carers and peace of mind. Key facilitators for successful implementation were a team-based approach, the role of the PHN, the role of practice champions, training facilitators’ ability to influence peers and facilitate change, and mentoring support. Barriers to implementation included issues related to workplace culture, cost, time/workload, patients and health system.Conclusion Findings suggest that the Advance Project approach facilitated successful implementation of ACP and PC needs assessment into usual care in general practices that encouraged teamwork among GPs and general practice nurses. The ability of the practice to make the best use of practical support and guidance available to them through their local PHN both before and during implementation was a key factor in integration of Advance Project resources into routine practice.

This study compared muscle activity and movement between the leading (Ld) and trailing (Tr) fore- (F) and hindlimbs (H) of horses cantering overground. Three-dimensional kinematic and surface electromyography (sEMG) data were collected from right triceps brachii, biceps femoris, middle gluteal, and splenius from 10 ridden horses during straight left- and right-lead canter. Statistical parametric mapping evaluated between-limb (LdF vs. TrF, LdH vs. TrH) differences in time- and amplitude-normalized sEMG and joint angle–time waveforms over the stride. Linear mixed models evaluated between-limb differences in discrete sEMG activation timings, average rectified values (ARV), and spatio-temporal kinematics. Significantly greater gluteal ARV and activity duration facilitated greater limb retraction, hip extension, and stifle flexion (p < 0.05) in the TrH during stance. Earlier splenius activation during the LdF movement cycle (p < 0.05), reflected bilateral activation during TrF/LdH diagonal stance, contributing to body pitching mechanisms in canter. Limb muscles were generally quiescent during swing, where significantly greater LdF/H protraction was observed through greater elbow and hip flexion (p < 0.05), respectively. Alterations in muscle activation facilitate different timing and movement cycles of the leading and trailing limbs, which justifies equal training on both canter leads to develop symmetry in muscular strength, enhance athletic performance, and mitigate overuse injury risks.

Knowledge of vertical motion patterns of the axial body segments is a prerequisite for the development of algorithms used in automated detection of lameness. To date, the focus has been on the trot. This study investigates the temporal synchronization between vertical motion of the axial body segments with limb kinematic events in walk and trot across three popular types of sport horses (19 Warmbloods, 23 Iberians, 26 Icelandics) that are known to have different stride kinematics, and it presents novel data describing vertical motion of the axial body segments in tölting and pacing Icelandic horses. Inertial measurement unit sensors recorded limb kinematics, vertical motion of the axial body at all symmetrical gaits that the horse could perform (walk, trot, tölt, pace). Limb kinematics, vertical range of motion and lowest/highest positions of the head, withers and pelvis were calculated. For all gaits except walk and pace, lowest/highest positions of the pelvis and withers were found to be closely related temporally to midstance and start of suspension of the hind/fore quarter, respectively. There were differences in pelvic/withers range of motion between all breeds where the Icelandic horses showed the smallest motion, which may explain why lameness evaluation in this breed is challenging.

Conformation of the hooves and distal limbs of foals and factors influencing their morphological development have not been reported in detail for the Thoroughbred breed. In this paper we explore morphogenesis of the equine distal limb in Thoroughbred foals with emphasis on adaptations in response to weight bearing early in life that prepare the foal for an athletic career. Novel data from four studies are presented chronologically during key time periods to illustrate specific aspects of distal limb growth and adaptation. Dorsal epidermal thickness increased from 2.84 ± 0.41 mm in utero to 4.04 ± 1.10 mm by 4 months of age. The increase in thickness was accompanied by decreased tubular density, increased inter-tubular material, and an increase in number and size of tubules at the quarters, which provided a malleable hoof capsule to allow for skeletal growth. Between 4–6 months of age, the hoof widens, and higher loading on the medial side (>60%) vs. the lateral side (

Background Antiplatelet agents are increasingly used in cardiovascular treatment. Limited research has been performed into risks of acute and delayed traumatic intracranial hemorrhage (ICH) in these patients who sustain head injuries. Our goal was to assess the overall odds and identify factors associated with ICH in patients on antiplatelet therapy.Methods A retrospective observational study was conducted at two level I trauma centers. Adult patients with head injuries on antiplatelet agents were enrolled from the hospitals’ trauma registries. Acute ICH was diagnosed by head CT. Observation and repeat CT to evaluate for delayed ICH was performed at clinicians’ discretion. Patients were stratified by antiplatelet type and analyzed by ICH outcome.Results Of 327 patients on antiplatelets who presented with blunt head trauma, 133 (40.7%) had acute ICH. Three (0.9%) had delayed ICH on repeat CT, were asymptomatic and did not require neurosurgical intervention. One with delayed ICH was on clopidogrel and two were on both clopidogrel and aspirin. Patients with delayed ICH compared with no ICH were older (94 vs 74 years) with higher injury severity scores (15.7 vs 4.4) and trended towards lower platelet counts (141 vs 216). Patients on aspirin had a higher acute ICH rate compared with patients on P2Y12 inhibitors (48% vs 30%, 18% difference, 95% CI 4 to 33; OR 2.18, 95% CI 1.15 to 4.13). No other group comparison had significant differences in ICH rate.Conclusions Patients on antiplatelet agents with head trauma have a high rate of ICH. Routine head CT is recommended. Patients infrequently developed delayed ICH. Routine repeat CT imaging does not appear to be necessary for all patients.Level of evidence Level III, prognostic.

As a first step in achieving an evidence-based classification system for the sport of Para Dressage, there is a clear need to define elite dressage performance. Previous studies have attempted to quantify performance with able-bodied riders using scientific methods; however, definitive measures have yet to be established for the horse and/or the rider. This may be, in part, due to the variety of movements and gaits that are found within a dressage test and also due to the complexity of the horse-rider partnership. The aim of this review is therefore to identify objective measurements of horse performance in dressage and the functional abilities of the rider that may influence them to achieve higher scores. Five databases (SportDiscuss, CINAHL, MEDLINE, EMBASE, VetMed) were systematically searched from 1980 to May 2018. Studies were included if they fulfilled the following criteria: (1) English language; (2) employ objective, quantitative outcome measures for describing equine and human performance in dressage; (3) describe objective measures of superior horse performance using between-subject comparisons and/or relating outcome measures to competitive scoring methods; (4) describe demands of dressage using objective physiological and/or biomechanical measures from human athletes and/or how these demands are translated into superior performance. In total, 773 articles were identified. Title and abstract screening resulted in 155 articles that met the eligibility criteria, 97 were excluded during the full screening of articles, leaving 58 included articles (14 horse, 44 rider) involving 311 equine and 584 able-bodied human participants. Mean ± sd (%) quality scores were 63.5 ± 15.3 and 72.7 ± 14.7 for the equine and human articles respectively. Significant objective measures of horse performance (n = 12 articles) were grouped into themes and separated by gait/movement. A range of temporal variables that indicated superior performance were found in all gaits/movements. For the rider, n = 5 articles reported variables that identified significant differences in skill level, which included the postural position and ROM of the rider’s pelvis, trunk, knee and head. The timing of rider pelvic and trunk motion in relation to the movement of the horse emerged as an important indicator of rider influence. As temporal variables in the horse are consistently linked to superior performance it could be surmised that better overall dressage performance requires minimal disruption from the rider whilst the horse maintains a specific gait/movement. Achieving the gait/movement in the first place depends upon the intrinsic characteristics of the horse, the level of training achieved and the ability of the rider to apply the correct aid. The information from this model will be used to develop an empirical study to test the relative strength of association between impairment and performance in able-bodied and Para Dressage riders.

This study addresses the presence and location of oral lesions in 342 dressage, show jumping, and eventing horses examined at an obligatory veterinary inspection before competing in the Danish National Championship in 2020. Ulcers in the lip commissures were photographed for subsequent pathological analysis. If a lesion was found at the lip commissures on one side, there was an increased risk of finding a similar lesion on the other side (ulcer: p < 0.0001; scarring/depigmentation: p < 0.0001; fissure: p = 0.002; erosion/contusion: p < 0.0001). At the lip commissures, external (cutaneous) ulcers were correlated with internal (mucosal) ulcers (p < 0.0001) and with scarring/depigmentation (p < 0.0001). Both mucosal and cutaneous ulcers were correlated with scarring/depigmentation (p < 0.0001). Erosion/contusion at the lip commissures was associated with similar lesions on the bars (p = 0.0002), and ulcers of the buccal mucosa were associated with ulcers on the bars (p = 0.003). Dental hooks or sharp enamel points on one side were associated with similar lesions on the other side (p < 0.0001). Dental findings were not related to mucosal ulcers or erosion/contusion at the lip commissures but were associated with scarring/depigmentation (p = 0.01).

Background: Novel, non-invasive diagnostic biomarkers that facilitate early intervention in head and neck cancer are urgently needed. Polyamine metabolites have been observed to be elevated in numerous cancer types and correlated with poor prognosis. The aim of this study was to assess the concentration of polyamines in the saliva and urine from head and neck cancer (HNC) patients, compared to healthy controls. Methods: Targeted metabolomic analysis was performed on saliva and urine from 39 HNC patient samples and compared to 89 healthy controls using a quantitative, targeted liquid chromatography mass spectrometry approach. Results: The metabolites N1-acetylspermine (ASP), N8-acetylspermidine (ASD) and N1,N12-diacetylspermine (DAS) were detected at significantly different concentrations in the urine of HNC patients as compared to healthy controls. Only ASP was detected at elevated levels in HNC saliva as compared to healthy controls. Conclusion: These data suggest that assessment of polyamine-based metabolite biomarkers within the saliva and urine warrants further investigation as a potential diagnostic in HNC patients.

One of the goals of the neuromotor control system is to minimize the cost of locomotion by reducing mechanical energy losses. Collisional mechanics, which studies the redirection of the downwards motion of the center of mass (COM) by ground reaction forces (GRF) generated by the limbs, represents an important source of energy loss. The primary objective of this study was to compare collisional mechanics and the associated mechanical energy losses in horses performing diagonally-synchronized gaits over a range of speeds. It is to be expected that collisional energy losses will be high when the COM velocity vector is closely aligned with the GRF vector. This condition is achieved in piaffe, an artificial gait performed in dressage competitions that has a diagonal limb coordination pattern similar to trot but performed with little or no forward velocity. Therefore, we hypothesized that collisional energy losses would be higher in piaffe than in trot. Synchronized kinematic and GRF data were collected from three highly-trained horses performing piaffe, passage and trot at a range of speeds. Derived variables were vertical excursion and velocity of the trunk COM, fore and hind limb compression expressed as percentage reduction of standing limb lengths, range of limb pro-retraction, GRF vector magnitude and vector angle, collision angle (Φ), and mechanical cost of motion (CoMotmech). Linear regression was used to investigate the relationship between CoMotmech and speed for each gait. Partial correlation was used to seek relationships between COM excursion and limb mechanics for each gait. Piaffe, passage and trot were clearly separated on the basis of speed. In all gaits the trunk was high at contact and lift off and descended to its lowest point in midstance following the pattern typical of spring mass mechanics. Mechanical cost was significantly (p